Van Zee sounded the alarm about OxyContin just as its makers were on the threshold of grossing its first billion on the blockbuster drug.
And though he didn’t yet know it, he would spend the remainder of his career dealing with its aftermath—lobbying policy makers, treating the addicted, and attending funerals of the overdosed dead.
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But back in the early days of OxyContin, Van Zee was as puzzled as he was concerned. He told Sue Cantrell about a new condition he’d spotted among some of his older opioid addicts—skin abscesses caused by injecting the crushed-up drug. He was beginning to think that OxyContin, especially in its 40- and 80-milligram forms, was another animal entirely from the 10-milligram Percocet pills some teenagers used recreationally on the weekends. His region had long been home to prescription drug abuse, though to a much smaller degree; before OxyContin, Van Zee treated only one to three narcotic-dependent patients a year.
But he was starting to get regular phone calls from worried parents about their young-adult kids. Jobs, homes, spouses, and children were being lost to OxyContin addiction. A banker he knew had already spent $80,000 of his savings after his son used his credit cards to buy items he could trade for Oxys.
Down the hall from his office, a physician colleague treated a septuagenarian farmer who had owned land worth $500,000. Within six months, the man had sold everything he had to keep his addiction fed. “It’s over,” he told his doctor. “The kids are gone. The wife’s gone. The farm’s gone.”
The doctors were witnessing the same thing that Lieutenant Stallard had seen a year earlier, in 1997, on the streets. “We had always had people using Lortabs and Percocets, but they were five- or ten-milligram pills you could take every day and still function. They didn’t have to have more,” Stallard said.
“The difference with OxyContin was, it turned them into nonfunctioning people.”
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Convinced about the looming crisis, Cantrell, the region’s top public health official, called the public health commissioner in Richmond in the late 1990s. “I said, look, we’ve had substance abuse problems for years,” she said. “But this was a new kind of chemical, much more potent than anything we’d seen from the small subset of addicts we’d had since the seventies or eighties.”
She was told it was a problem for the Department of Behavioral Health and Substance Abuse Health Services. Even though the infections put people at risk of tuberculosis, and the shared needles (and snorting straws) could hasten the spread of hepatitis C and HIV, the buck was passed. Officially, this was not a public health matter.
“Nobody would listen to her,” said Dr. Molly O’Dell, then a fellow health-department director several counties to the east. “But she was right there in the epicenter of where the pills started. She’s the first person I ever heard to name it. She called me and said, ‘Molly, I think we’ve got an epidemic down here.’”
In 1997, the Roanoke-based medical examiner counted one OxyContin death in southwest Virginia, the next year three, and the year after that sixteen.
But those numbers were inexplicably unexposed until 2001, five years after Purdue launched its drug. A Drug Enforcement Administration official told a Richmond reporter that illicit opioids were unlikely to spread beyond the mountains to the state capital, declaring southwest Virginia “a little bit unique,” although he conceded there were other Oxy-abuse hot spots in rural Maine, Cincinnati, Baltimore, and Charleston, West Virginia.
Contacted by the same Richmond reporter, a spokesman for Purdue Pharma declined to discuss the illicit use of the company’s drug.
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So it happened that in the early 2000s Debbie Honaker, a happily married twenty-seven-year-old mother from the town of Lebanon, two counties to the east of Van Zee, recovered from a fairly routine gallbladder surgery with a thirty-day prescription of “Oxy tens,” followed by another script at her postsurgery checkup for another month’s supply, this time for Oxy forties. When she called to complain that her incision was still hurting, the surgeon gave her a third prescription, for 7.5-milligram Percocet, designed to quell her “breakthrough pain,” with instructions to take it not “as needed for pain” but as frequently as every two hours—concurrent with the twelve-hour Oxys. To remind her to take the Percocet, she was supposed to set an alarm for the middle of the night.
“The doctor didn’t force me to take them,” Honaker said. “But they’re like a high-standard person, someone you’re supposed to trust and believe in. My husband and I both understood that I was supposed to take the pills every two hours.”
They have discussed that defining moment a lot in the intervening years. They’ve wondered aloud what might have happened had her gallbladder not given out at the same time the factories and mines were laying off and shutting down.
She might not have visited a neighbor, a well-known pill abuser, for advice on what to do when the pain wouldn’t subside. “If you snort ’em up your nose, they hit you better,” her neighbor told her.
She might not have found herself doubled over and dopesick the day her prescriptions ran out. “You’re throwing up. You have diarrhea. You ache so bad and you’re so irritable that you can’t stand to be touched. Your legs shake so bad you can’t sleep. You’re as ill as one hornet could ever be,” she recalled.
“And believe me, you’ll do anything to make that pain go away.”
She might not have later turned, in the throes of withdrawal, to her sixty-year-old neighbor, Margie, one of the growing legions of laid-off workers in town. Or suggested that, given Margie’s bad hip from decades of standing on hard factory floors, she should go visit the town’s so-called pain doctor and ask him to “write you”—parlance for coaxing a prescription out of a doctor by making the pain seem more debilitating than it really is. She might not have driven Margie to the appointment, then coached her on what to say.
“She didn’t want to do it,” Honaker recalled. “Margie would say, ‘God knows I wouldn’t be doing this if I didn’t have to choose between paying a bill or going to the doctor to get the medicines I really need,’” for diabetes and high blood pressure.
Within the span of three months, Honaker had mastered the classic drug-seeking emergency-room trick, beginning with an impassioned complaint about kidney stone pain. “I’d say, ‘My back’s killing me,’ and [in the ER bathroom] I’d pierce my finger, then put a drop of blood into my urine sample,” she recalled.
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She’d leave with a prescription for Percocet. She was a full-blown opioid addict when she resorted to stealing the money her husband set aside for paying the electric bill and spending it at the office of a well-known Lebanon doctor who began most of her visits to him with the question “What do you want?”
The Board of Medicine suspended Dr. Dwight Bailey’s license to practice medicine in 2014 for excessive prescribing and poor record keeping, noting that five patients had died from drug overdoses while under his care—but that was more than a decade after Honaker first came through his doors.
Honaker went on to steal painkillers from her husband’s elderly grandmother. She bought pills from people who paid one dollar for their OxyContin prescriptions using their Medicaid cards. “They’ve got to choose to eat or pay their electric bill. But if they’re on Medicaid, they can sell their drugs to supplement their income,” she said.